Improvements in awareness of and access to hospice and palliative care is happening in the context of a renewed push for a "death with dignity" law clarifying patients’ and doctors’ rights and protections concerning the use of drugs to end life.

Kathryn Tucker, director of legal affairs for the nonprofit organization Compassion and Choices, made public appearances asserting that Hawaii already provides that right through a "constellation" of other laws already on the books. This is so, she said, even if clear permission isn’t given for doctors to prescribe a drug to hasten death.

"The failure to enact a ‘permission’ is not a prohibition," she said.

Experts see some overlap between the physician-assisted suicide movement and advocacy for hospice and palliative care. Dr. John Berthiaume, HMSA vice president and medical director, said both drives affirm the need for education and outreach to patients and families and for acknowledgement of patients’ wishes.

But having access to physician-assisted suicide hinges on individual spiritual beliefs, he said, whereas acceptance of hospice and palliative services can exist independently of those beliefs.

James Pietsch, director of the University of Hawaii Elder Law Program, served on the Blue-Ribbon Panel on Living and Dying with Dignity during Gov. Ben Cayetano’s administration. Of the six positions the panel took, he said, on only one did members fail to reach unanimous agreement: the recommendation for a "death with dignity" law.